Drug List - E

E
Drug Name Tier Restrictions
E.E.S -200 1
ECONAZOLE NITRATE 1 Quantity limit
EDECRIN 3
EDEX KIT 3 Prior authorization
EFFEXOR 3 Prior authorization
EFFEXOR XR 3 Prior authorization
EFFIENT 2
EFUDEX 3 Prior authorization, Quantity limit
ELDEPRYL 3
ELESTAT 3 Prior authorization
ELIDEL 2 Prior authorization, Quantity limit
ELIGARD KIT 3 Prior authorization
ELIQUIS 2
ELLA TAB 30MG NC Quantity limit
ELOCON 3 Quantity limit
EMADINE 3
EMCYT 2
EMEND 3 Prior authorization
EMSAM DIS 3 Prior authorization, Step therapy
ENABLEX 3
ENALAPRIL MALEATE 1
ENALAPRIL MALEATE/HYDROCHLO 1
ENBREL 2
ENDOCET 1
ENDOMETRIN SUPP. 3
ENJUVIA 2
ENOXAPARIN INJ 1
ENPRESSE 1*
ENTECAVIR TAB 0.5MG 1
ENTOCORT EC 2
ENTRESTO TAB 49-51MG 3 Prior authorization
EPCLUSA 2 Prior authorization
EPIDUO GEL 0.1-2.5% 3 Prior Authorization
EPIDUO FORTE GEL 0.3-2.5% 3 Prior
EPIFOAM AER 3 Quantity limit
EPINASTINE DROP 0.05% 1
EPINEPHRINE 1
EPIPENS 3 Prior Authorization
EPIQUIN MICRO 2 Quantity limit
EPIVIR 3 Prior authorization
EPIVIR HBV 2
EPLERENONE 3
EPZICOM 3 Prior authorization
ERRIN 1*
ERTACZO 3 Prior authorization, Quantity limit, Step therapy
ERY PAD 3 Quantity limit
ERY-TAB 2
ERYPED-200 1
ERYTHRO/SULFISOX 1
ERYTHROCIN 1
ERYTHROCIN STE FILMTAB 1
ERYTHROMYCIN 1
ERYTHROMYCIN GEL 2% 1 Quantity limit
ERYTHROMYCIN OIN OP 1
ERYTHROMYCIN/BENZOYL PEROXI GEL 1 Quantity limit, Step therapy
ESCITALOPRAM 1
EST ESTROGEN TAB MTEST HS 1
ESTAZOLAM TAB 1MG
ESTRACE CRE 2
ESTRACE TAB 3 Prior authorization
ESTRADERM DIS 3 Prior authorization
ESTRADIOL 1
ESTRADIOL DIS 1
ESTRADIOL/NORET 1
ESTRATEST-H.S. 3
ESTRING MIS 2
ESTROG/MTEST TAB 1.25-2.5 1
ESTROGEL 3
ESTROSTEP FE 3 Prior authorization
ESZOPICLONE 1
ETHAMBUTOL HCL $0
ETHEDENT 1
ETHOSUXIMIDE 1
ETHYL CHLOR AER MIST 1
ETODOLAC 1
ETODOLAC ER 1
EUFLEXXA INJ 10MG/ML UD 3 Quantity limit, Step therapy
EURAX 1 Quantity limit
EVAMIST SPR 1.53MG 3
EVISTA 3
EVOCLIN 3 Prior authorization, Quantity limit, Step therapy
EVOXAC 3 Quantity limit
EXELON 3 Prior authorization
EXELON DIS 2
EXEMESTANE TAB 25MG 1
EXFORGE 2
EXFORGE HTC 2
EXTAVIA 3 Prior authorization, Step therapy
EXTINA AE 3 Prior authorization, Quantity limit, Step therapy
EYLEA 3
EZETIMIBE 1
EZETIMIDE/SIMVASTATIN 1